Introduction
Cauda Equina Syndrome is a serious and potentially debilitating condition. Derived from the Latin term “equine” for horse, the name describes the mass of nerve roots at the lower end of the spinal canal resembling a ‘mare’s tail’ or ‘cauda equina’. These nerve roots branch off the spinal cord’s lower end, joining other nerves which travel towards the bladder, anus, and feet.
Causes of Cauda Equina Syndrome
Several factors can lead to Cauda Equina Syndrome:
- Compression or disturbance in the function of the cauda equina can disable these nerves. Common causes include a central disc prolapse.
- Chronic spinal inflammatory conditions, such as Paget’s disease, stenosis, and spine instability.
- External factors like injury, trauma, wounding, surgery, and anaesthetics.
- At the Spinal Foundation, it’s believed that certain individuals have a higher susceptibility to this condition.
Symptoms
Symptoms can vary significantly among patients:
- Rapid onset of muscle and sphincter weakness.
- Absence of pain in the back or legs.
- Complaints of sexual dysfunction, bladder control issues, or bowel control problems.
- Numbness around the anus, scrotum, or vagina, referred to as saddle anaesthesia.
- Leg weakness accompanied by pain and lack of ankle reflexes.
Treatment
Cauda Equina Syndrome is a surgical emergency:
- An urgent MRI scan is recommended.
- Surgical decompression to relieve pressure on the trapped nerves should be done within eight hours of symptom onset.
- Depending on the condition’s cause, treatments may involve the removal of abnormal bone growths, lesions, tumors, or haematoma.
- In cases of bacterial infection, antibiotics are administered after a decompression laminectomy.
- Inflammatory conditions might require steroids and decompression.
Likely Outcomes
The recovery trajectory is influenced by various factors:
- The severity and duration of nerve compression play a significant role.
- Generally, the longer the compression, the more severe the residual impairment.
- In some cases, nerve damage can be permanent.
- If the nerves are capable of re-growth, recovery time can be variable, with some cases taking several years.
- In many instances, irreversible damage occurs initially, determining the outcome despite timely and appropriate treatment.
